Transcript Implementing the WHO Global Code

Implementing the WHO Global Code:
the Irish Experience
Prof. Ruairí Brugha,
Department of Epidemiology and Public Health Medicine,
Royal College of Surgeons in Ireland (RCSI)
Lisbon, Portugal, 16th June 2014
1. About the WHO Global Code
• Developed by a partnership of the Global Policy Advisory Council
and WHO, 2007-2010
• Adopted by World Health Assembly (WHA 63) in 2010
• Voluntary principles + practices to be implemented by member
states for ethical recruitment and strengthening of health systems
• Main recommendations:
– Ethical international recruitment
– Health workforce development and health system sustainability
Train and Retain
– Fair treatment of migrant health personnel
– International cooperation
– Support to developing countries
– Data gathering, reporting and research
2. Ireland’s HRH Challenges: 2000-2013
• Between 2000 and 2008, the percentage of foreign trained
doctors increased from 12% to 35% - 25% of these doctors
coming from ‘high-burden’ countries
• Between 2000 and 2006, more than 50% of all nurses
registering in Ireland were non-Irish
• Ireland biggest recruiter of foreign trained nurses and second
biggest for doctors (in % terms) among OECD countries (2008)
• Due to economic crisis, there has been a reduction in health
workforce of 12,505 WTEs (-11%) since September 2007
• Ireland now produces sufficient graduates in medicine and
nursing, but is experiencing recruitment and retention
challenges across the public healthcare system
Nurses newly registered with Irish Nursing Board
2000-2010
N=31,810
Source: An Bord Altranais, 2010
Sources: Irish Nursing Board 2010; Nursing and Midwifery Council, 2008
Irish Registered Nurses ‘working abroad’ 20042010
Country of qualification all registered doctors: 2000-2010
Medical Council registrants by country of qualification (2000-2010)
Country of qualification for non-EU graduates: 2000 + 2010
2000
2010
1800
33.4%
number of doctors registered
1600
1400
1200
22.7%
17.0%
1000
800
13.4%
600
400
39.2%
9.7%
19.4%
200
8.3%
4.1%
8.3%
6.7%
8.2%
5.6%
3.8%
0
Pakistan
India
Egypt
Sudan
South
Africa
Nigeria
% indicates the proportion of total non-EU registrations
Other
Country of qualification for EU graduates (excl Ireland):
2000 + 2010
2000
700
2010
44.2%
number (n) of doctors on register
76.9%
600
500
400
300
15.1%
12.1%
200
7.9%
100
7.0%
5.5%
3.7%
3.1%
0%
0.3%
3.6%
0.3%
Poland
Hungary
Romania
0
UK
Germany
Italy
11.9%
% indicates the proportion of total EU registrations
Other
3. Ireland and the WHO Global Code
• Committed to principles of Global Code including health
worker self-sufficiency and ethical international recruitment
• Collaborative implementation: Ireland’s Dept of Health, Dept
of Foreign Affairs (Irish Aid) and Health Service Executive (HSE)
– MoU between the Health Service Executive and Irish Aid to
enhance collaboration on global health issues including HRH (2010)
– Establishment and roll-out of the International Medical Graduate
Training Initiative (2011-2013)
– Agreed commitments for 3rd Global Forum on HRH, Recife (2013)
– Currently developing long-term strategic health workforce planning
framework and approach (2014-2015)
• Ireland’s work on Code implementation recognised in 2013
Health Worker Migration Policy Council Innovation Award
• Strong links between policy, planning and research – next ..
4. Research: Doctor Migration (IMG) 2010-14
• Mixed method study of inward migration of non-EU migrant
doctors (IMGs) to Ireland:
– Qualitative interviews (N=37)
– Quantitative survey (N=337)
• IMG respondents came to Ireland for career progression and to
obtain further training/qualifications
• Mismatch between expectations of IMGs and the reality:
– most ended in service posts providing limited / no training
– therefore limited career progression.
Publications:
A cycle of brain gain, waste and drain – a qualitative study of non-EU migrant
doctors in Ireland. Humphries et al. ….. Human Resources for Health 2013: 11:63
‘I am kind of in stalemate’. The experiences of non-EU migrant doctors in Ireland
Humphries et al. Ch 10, Health Professional Mobility in a changing Europe. 2014
4. Research findings (hot off the press!) point to:
Onward – not Return - Migration
Country of
Training
Pakistan
Total
Staying in
number (N) Ireland (n)
Returning
home (n)
Migrating
elsewhere (n)
81
31
9
41
Ireland
57
10
0
47
South
Africa
Nigeria
41
7
13
21
38
17
4
17
Sudan
28
4
5
19
Other
57
20
13
24
TOTAL
343
104
57
182
30.3%
16.6%
53.1%
Percent
5. International Medical Graduate Training
Initiative (2011 – present)
• Underpinned by Global Code and principle of reciprocity
• Enables suitably qualified overseas postgraduate medical
trainees to undertake fixed period of clinical training in Ireland
• Structured training program developed by Irish postgraduate
medical training body to meet the clinical needs of participants
as defined by their home country’s health service
• Established in 2011 – first bi-lateral agreement signed with
College of Physicians and Surgeons of Pakistan (CPSP)
• Launched in 2013 – joint pilot with the CPSP
• Continued roll-out in 2014 – c. CPSP 100 trainees offered posts
under the Initiative following joint selection process
6. Features of the IMGTI
• Aimed primarily at doctors (International Medical Graduates –
IMGs) from countries with less developed health sectors
• Period of clinical training is ordinarily 24 months
• After the 24 month period elapses, participants return to their
country of origin
• Training provided in clinical departments approved for postgraduate specialist training in Ireland provided that training
position is incorporated into an IMG training programme :
– that is tailored to the educational/training objectives of the
participant
– that takes into account the needs of the health service in the
doctor’s home country
7. IMGTI Governance
• International Medical Graduate Training Initiative (IMGTI)
overseen by Ireland’s Health Service Executive (HSE) and the
Forum of Irish Postgraduate Medical Training Bodies
• National level committee comprising representatives of both
bodies
• National IMGTI framework developed and adopted in January
2014
• Responsibility for policy roll-out and implementation – HSE
Medical Education and Training Unit
• Close cooperation with relevant Government Departments in
relation to appropriate visa and work permit arrangements
8. Developing the IMGTI – Next Steps
• Discussions ongoing with other interested countries
• Enhancing alignment of medical training with needs of
home country health services
• Encouraging applications for different levels of training
relevant to home country health service needs e.g. in
sub-specialties such as oncology
• Review of the first phase of roll-out of the Initiative with
the first cohort of CPSP trainees in 2015
9. Finally: Addressing Health Workforce
Weaknesses in the Irish Health System
Research: Doctor Emigration Project, 2014-16
• Collaboration between RCSI researchers, Medical Council of Ireland and
HSE-MET
• Circa 600 Irish doctors responded in May June 2014 to questions on
emigration nested in Medical Council Trainee survey
• Findings even hotter off the press!
– One quarter of Irish trainee doctors will probably / definitely emigrate
– One quarter undecided
– Half will probably / definitely stay
• Qualitative study and cohort (follow-up) tracking study planned (201516)